Full Text of HB3512

LRB104 09276 BAB 19334 b

104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB3512

Introduced 2/18/2025, by Rep. Kam Buckner

SYNOPSIS AS INTRODUCED:

210 ILCS 85/10.9
210 ILCS 85/10.15 new
210 ILCS 85/10.20 new
210 ILCS 85/10.25 new
210 ILCS 85/10.30 new

Amends the Hospital Licensing Act. Requires hospitals licensed under the Act to employ and schedule enough hospital workers to provide quality patient care and ensure patient safety. Establishes requirements concerning the reporting of staffing metrics for hospitals and the Department of Public Health. Sets forth provisions concerning competency validation credentials for each hospital worker hired; assignment despite objection forms and procedures; and an assignment despite objection resolution process. Provides that a hospital may not assign a certified nursing assistant or patient care technician to more than 7 patients at a time during a day or evening shift or more than 11 patients at a time during a night shift. Sets forth provisions concerning direct-care registered nurse-to-patient staffing ratios and deviations from the ratio; complaint procedures; the Department's duties concerning complaints; meal and rest periods; investigations for violating staffing requirements; penalties and violations; recordkeeping requirements of a hospital; and rulemaking by the Department.

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Hospital Licensing Act is amended by changing Section 10.9 and by adding Sections 10.15, 10.20, 10.25, and 10.30 as follows:

(210 ILCS 85/10.9)

Sec. 10.9. Hospital worker Nurse mandated overtime prohibited.

(a) Definitions. As used in this Section:

"Hospital worker" means any person who receives an hourly wage directly or indirectly via a subcontractor by a hospital licensed under this Act.

"Mandated overtime" means work that is required by the hospital in excess of an agreed-to, predetermined work shift. Time spent by nurses required to be available as a condition of employment in specialized units, such as surgical nursing services, shall not be counted or considered in calculating the amount of time worked for the purpose of applying the prohibition against mandated overtime under subsection (b).

"Nurse" means any advanced practice registered nurse, registered professional nurse, or licensed practical nurse, as defined in the Nurse Practice Act, who receives an hourly wage and has direct responsibility to oversee or carry out nursing care. For the purposes of this Section, "advanced practice registered nurse" does not include a certified registered nurse anesthetist who is primarily engaged in performing the duties of a nurse anesthetist.

"Subcontractor" means any entity, including an individual or individuals, that contracts with a hospital licensed under this Act to supply a service. "Subcontractor" includes an organization that, to a significant extent, is associated or affiliated with, owns or is owned by, or has control of or is controlled by, the entity furnishing services to a hospital licensed under this Act.

"Unforeseen emergent circumstance" means (i) any declared national, State, or municipal disaster or other catastrophic event, or any implementation of a hospital's disaster plan, that will substantially affect or increase the need for health care services or (ii) any circumstance in which patient care needs require specialized nursing skills through the completion of a procedure. An "unforeseen emergent circumstance" does not include situations in which the hospital fails to have enough nursing staff to meet the usual and reasonably predictable patient care nursing needs of its patients.

(b) Mandated overtime prohibited. No hospital worker nurse may be required to work mandated overtime except in the case of an unforeseen emergent circumstance when such overtime is required only as a last resort. Such mandated overtime shall not exceed 4 hours beyond an agreed-to, predetermined work shift.

(c) Rest period required Off-duty period. When a hospital worker nurse is mandated to work up to 12 consecutive hours, the hospital worker nurse must be allowed at least 8 consecutive hours of off-duty time off immediately following the completion of a shift.

(d) Retaliation prohibited. No hospital may discipline, discharge, or take any other adverse employment action against a hospital worker nurse solely because the hospital worker nurse refused to work mandated overtime as prohibited under subsection (b).

(e) Violations. Any employee of a hospital that is subject to this Act may file a complaint with the Department of Public Health regarding an alleged violation of this Section. The complaint must be filed within 45 days following the occurrence of the incident giving rise to the alleged violation. The Department must forward notification of the alleged violation to the hospital in question within 3 business days after the complaint is filed. Upon receiving a complaint of a violation of this Section, the Department may take any action authorized under Section 7 or 9 of this Act.

(f) Proof of violation. Any violation of this Section must be proved by clear and convincing evidence that a hospital worker nurse was required to work overtime against the hospital worker's his or her will. The hospital may defeat the claim of a violation by presenting clear and convincing evidence that an unforeseen emergent circumstance, which required overtime work, existed at the time the employee was required or compelled to work.

(Source: P.A. 100-513, eff. 1-1-18.)

(210 ILCS 85/10.15 new)

Sec. 10.15. Additional staffing transparency and reporting requirements.

(a) Definitions. As used in this Section:

"Hospital worker" means any person who receives an hourly wage directly or indirectly via a subcontractor by a hospital licensed under this Act.

"Staffing metric" means any tool used by hospital management to determine safe staffing levels in a patient care or support services unit.

"Subcontractor" means any entity, including an individual or individuals, that contracts with a hospital licensed under this Act to supply a service. "Subcontractor" includes an organization that, to a significant extent, is associated or affiliated with, owns or is owned by, or has control of or is controlled by, the entity furnishing services to a hospital licensed under this Act.

"Unit' means a functional division of a hospital that provides patient care or support services.

(b) Hospitals licensed under this Act must employ and schedule enough hospital workers to provide quality patient care and ensure patient safety.

(c) In order to ensure compliance with safe staffing practices, hospitals licensed under this Act must make available upon request all the staffing matrices or other staffing metrics used to assess and maintain safe staffing levels for hospital workers in each unit.

(d) A hospital must share with the Department at the beginning of each calendar year any and all staffing matrices, staffing metrics, and underlying materials used to determine the metrics.

(e) The Department shall produce an annual report based on staffing disclosures required under this Section beginning the first year after the effective date of this amendatory Act of the 104th General Assembly.

(f) The Department shall make recommendations for minimum staffing standards for hospital workers in each hospital unit based on the information collected via this Section.

(210 ILCS 85/10.20 new)

Sec. 10.20. Hospital worker competency validation and assignment despite objection.

(a) Findings. The General Assembly finds that:

(1) The State of Illinois has an obligation to ensure hospitals provide quality patient care.

(2) Numerous studies have linked patient outcomes, including in-hospital mortality rates, to hospital worker staffing.

(3) Despite the preponderance of evidence that adequate staffing improves patient outcomes, hospitals in Illinois and elsewhere too often systemically and intentionally understaff to maximize profit, even at the expense of quality patient care.

(4) The COVID-19 pandemic both exposed and exacerbated these unsafe staffing practices.

(5) The State asserts that, based on their demonstrated competencies and training, hospital workers are best positioned to identify unsafe conditions that jeopardize quality patient care, especially short staffing.

(6) Hospitals perform competency validations and ongoing verifications to ensure hospital workers know how to perform their jobs safely and to identify unsafe practices, including short staffing.

(7) The State should require hospitals to affirm that hospital workers have received the necessary training to safely perform their work via competency validations and ongoing verification, and empower these hospital workers to identify and formally object to unsafe working conditions, including short staffing. (8) To facilitate this, the State should create a dispute resolution process for hospital workers to formally object to unsafe working conditions.

(b) Definitions. As used in this Section:

"Assignment despite objection" means a formal process by which hospital workers notify management when they receive an assignment that, based on their training, is potentially unsafe.

"Competent employee" means a hospital worker whose employer has received a competency validation or ongoing verification during a given calendar year.

"Competency validation" means a determination based on a hospital worker's satisfactory performance of each specific element of their job description and of specific requirements of the unit in which they are employed in a safe and ethical manner.

"Hospital worker" means any person who receives an hourly wage, directly or indirectly via a subcontractor, by a hospital licensed under this Act.

"Ongoing verification" means an annual redetermination based on a hospital worker's satisfactory performance of each specific element of their job description and the specific requirements of the unit in which they are employed in a safe and ethical manner.

"Subcontractor" means any entity, including an individual or individuals, that contracts with a hospital licensed under this Act to supply a service. "Subcontractor" includes an organization that, to a significant extent, is associated or affiliated with, owns or is owned by, or has control of or is controlled by, the entity furnishing services to a hospital licensed under this Act.

(c) Competency validation credential.

(1) Hospitals licensed under this Act shall conduct a competency validation for each hospital worker hired, as a condition of employment, within the first month of employment and at no cost to the new hire.

(2) The competency validation formally affirms the hospital has adequately trained a hospital worker to perform all aspects of their job safely and to identify unsafe conditions, including inadequate staffing.

(3) Hospitals must submit documentation of each hospital worker's competency validation to the Department within 2 weeks of the hospital worker's start date.

(4) Hospitals licensed under this Act shall also conduct an ongoing verification for each hospital worker employed during a given calendar year to determine each hospital worker's continued competency to perform their job. The hospitals shall submit documentation of each hospital worker's ongoing verification to the Department within 2 weeks of completion.

(5) Hospitals licensed under this Act shall submit a list of all competent employees currently employed at the end of each calendar year.

(6) The Department shall maintain, and make available to the public, a registry of all competent employees that includes the hospital worker's name, address, contact information, and current employer.

(7) Hospital employers that fail to comply with the requirements of this Section shall receive a fine equal to 0.1% of annual revenue reported during the most recently completed fiscal year each day until the hospital complies with the law.

(d) Assignment despite objection.

(1) A hospital licensed under this Act must create an assignment despite objection form that is applicable and accessible to all hospital workers that enables the hospital workers to formally object to unsafe working conditions (including unsafe staffing levels) and shifts liability for the unsafe working conditions to the hospital.

(2) The assignment despite objection form must include the following language: "This is to confirm that I notified you that, in my professional judgment derived from my competency validation, today's assignment is unsafe and places patients at risk. As a result, the facility is responsible for any adverse effects on patient care."

(3) A hospital must retain a copy of each assignment despite objection form and provide copies to the hospital worker's union (where relevant) and the Department. Hospitals must provide a report of all assignment despite objection forms filed annually at the end of each Calendar Year and maintain these records for a minimum of 5 years.

(4) A hospital must not retaliate against hospital workers for filing an assignment despite objection form or for reporting or objecting to unsafe conditions.

(e) Resolution process.

(1) A hospital must develop a transparent, fair, and expedient assignment despite objection resolution process for all hospital workers either via collective bargaining or in accordance with the Department process described in paragraph (3).

(2) Hospital workers currently covered by a collective bargaining agreement that includes an assignment despite objection resolution process shall abide by the process included in the collective bargaining agreement.

(3) Hospital workers not covered by a collective bargaining agreement that includes an assignment despite objection resolution process may use the Department's resolution process. The Department's resolution process for an assignment despite objection shall be as follows:

(A) Step 1: The objecting hospital worker shall make a good faith effort to inform their manager or supervisor at the time of the objection to assignment.

(B) Step 2: If the manager or supervisor fails to resolve the unsafe situation to the reporting hospital worker's satisfaction, the hospital worker shall then complete an assignment despite objection form and submit a copy to the manager or supervisor, submit a copy to the representative organization if covered by a collective bargaining agreement, and keep a copy for the hospital worker's records.

(C) Hospital management must respond in writing to the assignment despite objection within one week of its receipt and shall provide a copy of the response to the hospital worker's representative organization if the hospital worker is covered by a collective bargaining agreement.

(D) Should the affected hospital worker(s) be unsatisfied with the management's response, the hospital must convene a Safety Review Panel composed of 3 representatives selected by the hospital and 3 representatives selected by hospital workers via a transparent democratic process (the hospital workers' representatives need not be hospital employees). The panel shall attempt to resolve the dispute within 15 days of referral, unless extended by mutual consent.

(E) In the event the Safety Review Panel cannot resolve the dispute within 15 days of referral, the Department shall appoint a mutually agreed upon third-party neutral to assist in resolving the dispute. The third-party neutral shall make a binding decision to resolve the dispute.

(4) Hospital employers that refuse to honor the Department's assignment despite objection resolution process shall receive a fine equal to 0.1% of annual revenue reported each day during the most recently completed fiscal year until the hospital complies with the resolution process.

(5) The Department shall create a Hospital Safety Advocate position responsible for enforcing the new competency credentialing and assignment despite objection requirements and developing additional rules, as needed.

(210 ILCS 85/10.25 new)

Sec. 10.25. Certified nursing assistant & patient care technician to patient ratios. A hospital may not assign a certified nursing assistant or patient care technician to more than 7 patients at a time during a day or evening shift or more than 11 patients at a time during a night shift.

(210 ILCS 85/10.30 new)

Sec. 10.30. Direct-care registered nurse-to-patient staffing ratios.

(a) Definitions. As used in this Section:

"Charge nurse" means a direct-care registered nurse who coordinates patient care responsibilities among nurses in a hospital unit.

"Clinical care staff" means individuals who are licensed or certified by the State and who provide direct care.

"Direct care" means any care provided by a licensed or certified member of the hospital staff that is within the scope of the license or certification of the member.

"Direct-care staff" means any of the following who are routinely assigned to patient care and are replaced when they are absent:

(1) registered nurses, including registered nurses that do not assume primary responsibility for a patient's care but have responsibility for consulting on patient care;

(2) licensed practical nurses; or

(3) certified nursing assistants.

"Exclusive bargaining representative" means a labor organization that is:

(1) certified as an exclusive representative by the National Labor Relations Board; or

(2) certified as an exclusive representative by the Employment Relations Board.

"Intensive care unit" means a unit of a hospital that provides care to critically ill patients who require advanced treatments, such as mechanical ventilation, vasoactive infusions, continuous renal replacement treatment, or who require frequent assessment and monitoring.

"Intermediate care unit" means a unit of a hospital that provides progressive care, intensive specialty care, or step-down care.

"Medical-surgical unit" means an inpatient unit in which general medical or post-surgical level of care is provided, excluding critical care units and any units referred to in this Section.

"Progressive care" means care provided to hospital patients who need more monitoring and assessment than patients on the medical-surgical units but whose conditions are not so unstable that they require care in an intensive care unit.

"Step-down care" means care for patients transitioning out of the intensive care unit who require more care and attention than patients in a hospital's medical-surgical units.

"Valid complaint" means a complaint containing an allegation that, if assumed to be true, is a violation of this Section.

(b) With respect to direct-care registered nurses, a hospital must ensure that at all times:

(1) In an emergency department:

(A) a direct-care registered nurse is assigned to not more than one trauma patient; and

(B) the ratio of direct-care registered nurses to patients averages no more than one-to-four over a 12-hour shift and a single direct-care registered nurse may not be assigned more than 5 patients at one time. Direct-care registered nurses assigned to trauma patients may not be taken into account in determining the average ratio.

(2) In an intensive care unit, a direct-care registered nurse is assigned to no more than 2 patients.

(3) In a labor and delivery unit, a direct-care registered nurse is assigned to no more than:

(A) 2 patients if the patients are not in active labor or experiencing complications; or

(B) One patient if the patient is in active labor or if the patient is at any stage of labor and is experiencing complications.

(4) In a postpartum, antepartum, and well-baby nursery, a direct-care registered nurse is assigned to no more than 6 patients, counting mother and baby each as separate patients.

(5) In a mother-baby unit, a direct-care registered nurse is assigned to no more than 8 patients, counting mother and baby each as separate patients.

(6) In an operating room, a direct-care registered nurse is assigned to no more than one patient.

(7) In an oncology unit, a direct-care registered nurse is assigned to no more than 4 patients.

(8) In a post-anesthesia care unit, a direct-care registered nurse is assigned to no more than 2 patients.

(9) In an intermediate care unit, a direct-care registered nurse is assigned to no more than 3 patients.

(10) In a medical-surgical unit, a direct-care registered nurse is assigned to no more than 5 patients.

(11) In a cardiac telemetry unit, a direct-care registered nurse is assigned to no more than 4 patients.

(12) In a pediatric unit, a direct-care registered nurse is assigned to no more than 4 patients.

(c) Notwithstanding subsection (b), the direct-care registered nurse-to-patient ratio for an individual patient shall be based on a licensed independent practitioner's classification of the patient, as indicated in the patient's medical record, regardless of the unit where the patient is being cared for.

(d) With the approval of a majority of the members of the hospital nurse staffing committee, a unit can deviate from the direct-care registered nurse-to-patient ratios in subsection (b), in pursuit of innovative care models that were considered by the committee, by allowing other clinical care staff to constitute up to 50% of the registered nurses needed to comply with the applicable nurse-to-patient ratio. Staffing in an innovative care model must be reapproved by the committee every 2 years.

(e) A hospital shall provide for meal breaks and rest breaks in accordance with all rules and applicable laws.

(f) Each hospital unit may deviate, except with respect to meal breaks and rest breaks, from the applicable direct-care registered nurse-to-patient ratios under this Section, within a period of 12 consecutive hours, no more than 6 times during a rolling 30-day period, without being in violation of the nurse staffing plan. The unit manager must notify the hospital nurse staffing committee no later than 10 days after each deviation. Each subsequent deviation during the 30-day period constitutes a separate violation under Section 90.

(g) A hospital may not require a direct-care registered nurse to be assigned to more patients than as specified in this Section or in the nurse staffing plan approved by the hospital nurse staffing committee, as applicable.

(h) A charge nurse may:

(1) take patient assignments, including patient assignments taken for the purpose of covering staff who are on meal breaks or rest breaks, in units with 10 or fewer beds;

(2) take patient assignments, including patient assignments taken for the purpose of covering staff who are on meal breaks or rest breaks, in units with 11 or more beds with the approval of the hospital nurse staffing committee; and

(3) be taken into account in determining the direct-care registered nurse-to-patient ratio during periods when the charge nurse is taking patient assignments under this Section.

(i) Complaint procedure; meal and rest periods.

(1) An employee or an exclusive bargaining representative of an employee may enforce requirements for meal periods and rest periods adopted by rule by the Department by electing to file a complaint in one of the following ways:

(A) with the Department under this Section; or

(B) with the Department under rules adopted under this Section.

(2) Upon receipt of a complaint under this Section, the Department shall proceed on the complaint in accordance with this Section.

(3) The Department shall deem a complaint filed under this subsection to be withdrawn if notified by an employer that:

(A) the employer received a grievance filed by the employer or an exclusive bargaining representative of the employee alleging the same violation as the violation alleged in a complaint filed under this subsection; or

(B) the employee or the exclusive bargaining representative of the employee has filed a civil complaint against the employer alleging the same violation as the violation alleged in a complaint filed under this subsection.

(4) If the Department receives a complaint under subsection (b) that was filed more than 60 days after the date of the missed meal period or missed rest period alleged in the complaint, the Department:

(A) shall dismiss the complaint; and

(B) may not investigate the complaint or take any enforcement action with respect to the complaint.

(5) Following an investigation of a complaint filed under subsection (b), if the Department determines that a civil penalty is appropriate, the Department shall provide to the hospital, to the cochairs of the nurse staffing committee, and to the exclusive bargaining representative, if any, a notice of the Department's intent to assess a civil penalty of $200.

A civil penalty imposed under this Section:

(A) constitutes the liquidated damages of the complainant for the missed meal period or rest period;

(B) may not be combined with a penalty assessed in accordance with all applicable rules or laws;

(C) precludes any other penalty or remedy provided by law for the violation found by the commissioner; and

(D) becomes final if an application for hearing is not requested in a timely manner.

(6) The liquidated damages imposed under this Section shall be paid to the complainant no later than 15 business days after the date on which the order becomes final by operation of law or 15 days after the issuance of a decision on appeal. A hospital shall provide the commissioner proof of the payment of liquidated damages no later than 30 days after making the payment.

(7) An employee's failure to file a complaint under subsection (b) does not preclude the employee from pursuing any other remedy otherwise available to the employee under any provision of law.

(8) Nothing in this Section creates a private cause of action.

(j) The Department shall:

(1) implement a process for an employee or an employee's exclusive bargaining representative to file a complaint against a hospital under subsection (b) for missed meal periods and rest periods.

(2) forward to the Department any complaint filed under this Section no later than 14 days after the complaint is filed; and

(3) no later than 30 days after receiving a complaint under this Section, provide notice of the filing of the complaint to the following:

(A) the hospital;

(B) the co-chairs of the nurse staffing committee where applicable; and

(C) the exclusive bargaining representative, if any, of the employee filing the complaint.

(k) Staffing investigations.

(1) For the purpose of ensuring compliance with all applicable laws and rules, the Department shall:

(A) within 60 days after receiving a complaint against a hospital for violating a provision of this Section, conduct an on-site investigation of the hospital; and

(B) within 60 days after issuing an order requiring a hospital to implement a plan to correct a violation of this Section, conduct an investigation of the hospital to ensure compliance with the plan.

(2) When conducting an investigation of a hospital to ensure compliance with this Section, the Department shall, if the Department provides notice of the investigation to the hospital, provide notice of the investigation to the cochairs of the hospital nurse staffing committee and other applicable laws and rules.

(3) Following an investigation conducted under this Section, the Department shall provide a written report of the Department's findings to the hospital and the cochairs of the hospital nurse staffing committee.

(4) When conducting an investigation of a hospital to ensure compliance with all applicable laws and rules, the Department may:

(A) take evidence;

(B) take the depositions of witnesses in the manner provided by law in civil cases;

(C) compel the appearance of witnesses in the manner provided by law in civil cases;

(D) require answers to interrogatories; and

(E) compel the production of books, papers, accounts, documents, and testimony pertaining to the matter under investigation.

(l) Complaint procedures.

(1) As used in this Section, "valid complaint" means a complaint containing an allegation that, if assumed to be true, is a violation of this Section.

(2) To ensure compliance with all applicable laws and rules, the Department shall:

(A) establish a method by which a hospital staff person or an exclusive bargaining representative of a hospital staff person may submit a complaint through the Department's website regarding any violation of this Section;

(B) no later than 14 days after receiving a complaint, send a copy of the complaint to the exclusive bargaining representative, if any, of the staff person or staff persons who filed the complaint;

(C) no later than 30 days after receiving a valid complaint of a violation of this Section, open an investigation of the hospital and provide a notice of the investigation to the hospital and the cochairs of the nurse staffing committee established under this Section, or other lawfully established committees, and to the exclusive bargaining representative, if any, of the staff person or staff persons filing the complaint. The notice must include a summary of the complaint that does not include the complainant's name or the specific date, shift, or unit but does include the calendar week in which the complaint arose;

(D) not later than 80 days after opening the investigation, conclude the investigation and provide a written report on the complaint to the hospital, the cochairs of the nurse staffing committee, and the exclusive bargaining representative, if any, of the staff person or staff persons filing the complaint. The report:

(i) shall include a summary of the complaint;

(ii) shall include the nature of the alleged violation or violations;

(iii) shall include the Department's findings and factual bases for the findings;

(iv) shall include other information the Department determines is appropriate to include in the report; and

(v) may not include the name of any complainant, the name of any patient, or the names of any individuals that the Department interviewed in investigating the complaint;

(E) provide a notice of the civil penalty that complies with all applicable laws and rules, and to the hospital, the cochairs of the nurse staffing committee, and the exclusive bargaining representative, if any, of the staff person or staff persons who filed the complaint if the Department issues a warning or imposes one or more civil penalties based on the report described in this Section; and

(F) in determining whether to impose a civil penalty, consider all relevant evidence, including, but not limited to, witness testimony, written documents, and the observations of the investigator.

(3) A hospital subject to a valid complaint shall provide to the Department, no later than 20 days after receiving the notice under of this Section:

(A) the staffing plan that is the subject of the complaint;

(B) if relevant to the complaint, documents that show the scheduled staffing and the actual staffing on the unit that is the subject of the complaint during the period of time specified in the complaint; and

(C) documents that show the actions described in this Section, if any, that the hospital took to comply with the staffing plan or to address the issue raised by the complaint.

(4) In conducting an investigation, the Department shall review any document:

(A) related to the complaint that is provided by the exclusive bargaining representative that filed the complaint or by the hospital staff person who filed the complaint and the person's exclusive bargaining representative, if any; and

(B) provided by the hospital in response to the complaint.

(5) In conducting an investigation, the Department may:

(A) make an on-site inspection of the unit that is the subject of the complaint;

(B) interview a manager for the unit and any other staff persons with information relevant to the complaint;

(C) interview the cochairs of the nurse staffing committee;

(D) interview the staff person or staff persons who filed the complaint unless the individual declines to be interviewed; and

(E) compel the production of books, papers, accounts, documents, and testimony pertaining to the complaint, other than documents that are privileged or not otherwise subject to disclosure.

(6) A complaint by a hospital staff person or the staff person's exclusive bargaining representative must be filed no later than 60 days after the date of the violation alleged in the complaint. The Department may not investigate a complaint or take any enforcement action with respect to a complaint that has not been filed timely.

(m) Penalties.

(1) The Department shall impose civil penalties in the manner provided for, or suspend or revoke a license of a hospital, for a violation of any provision of this Section. The Department shall adopt by rule a schedule establishing the amount of civil penalty that may be imposed for a violation of this Section when there is a reasonable belief that safe patient care has been or may be negatively impacted.

(2) The Department may suspend or revoke the license of a hospital, in the manner provided by law or rule, for a violation described in this Section.

(3) Each violation shall be considered a separate violation and there is no limit on the number times that a penalty may be imposed for repeated violations of the same provision.

(4) The Department shall maintain for public inspection records of any civil penalties or license suspensions or revocations imposed on hospitals penalized under this Section.

(n) Violations.

(1) Following the receipt of a complaint and completion of an investigation described in this Section, for a violation described in this Section, the Department shall:

(A) issue a warning for the first violation in a 4-year period;

(B) impose a civil penalty of $1,750 for the second violation of the same provision in a 4-year period;

(2) impose a civil penalty of $2,500 for the third violation of the same provision in a 4-year period; and

(3) impose a civil penalty of $5,000 for the fourth and subsequent violations of the same provision in a 4-year period.

(4) The Department shall take the actions described in paragraph (1) of this subsection for the following violations by a hospital of this Section:

(A) failure to comply with the nurse-to-patient staffing ratios prescribed in this Section;

(B) failure to comply with the staffing requirements for certified nursing assistants in this Section; or

(C) requiring a nursing staff, except as allowed by applicable law or rule to work:

(i) beyond an agreed-upon prearranged shift regardless of the length of the shift;

(ii) more than 48 hours in any hospital-defined work week;

(iii) more than 12 hours in a 24-hour period; or

(iv) during the 10-hour period immediately following the 12th hour worked during a 24-hour period.

(3) A direct-care staff person may elect to enforce meal break and rest break violations under this Section and other applicable laws and rules by filing a complaint with the Department in accordance with this Section.

(o) Public records. The Department shall post on a website maintained by the Department:

(1) reports of audits described in this Section of the hospital staffing plans received by the Department;

(2) any report of this Section made pursuant to an investigation under this Section;

(3) any order requiring a hospital to implement a plan to correct a violation;

(4) any order imposing a civil penalty against a hospital or suspending or revoking the license of a hospital pursuant; and

(5) any other matter recommended by the Illinois Nursing Workforce Center and Advisory Board.

(o) Recordkeeping. A hospital shall keep and maintain records necessary to demonstrate compliance with this Section. For purposes of this Section, the Department shall adopt rules specifying the content of the records and the form and manner of keeping, maintaining, and disposing of the records. A hospital must provide records kept and maintained under this Section to the Department upon request.

(p) Rulemaking. The Department may adopt any rules necessary for implementation of this Section.